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Questions and Answers
Which muscle is part of the first layer of intrinsic muscles on the plantar aspect of the foot?
What is the primary function of Lumbricals in the plantar aspect of the foot?
Which intrinsic muscle is responsible for assisting with toe flexion in the sagittal plane?
Which ligaments are associated with lateral ankle stability?
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What do the interossei muscles assist with in the foot?
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Which structure serves as the location for the insertion of the plantar fascia?
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What is the primary function of the central band of the plantar fascia?
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What are common causes of fractures in the ankle and foot?
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Which imaging method is seldom required for diagnosing foot fractures?
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Which ligament is not involved in the support of the ankle joint?
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The thickest and strongest band of the plantar fascia is commonly referred to as what?
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What is a common symptom of an ankle or foot fracture?
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Which tendon is associated with the retinaculum mentioned in the content?
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What is the primary function of sesamoid bones in the foot?
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Which of the following describes the anterior-posterior axis of rotation?
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What is the reported normal range of motion for dorsiflexion of the ankle?
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In which plane does the talus roll during plantarflexion?
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What is the primary movement produced by the coupled motion of dorsiflexion, abduction, and eversion?
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What is the anatomical relationship of the medial malleolus to the lateral malleolus?
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What is the ratio of inversion-to-eversion movement in the subtalar joint?
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What describes the axis of the subtalar joint in relation to the sagittal plane?
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What is the prevailing understanding of the cause of plantar fasciitis?
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Which symptom is characteristic of plantar fasciitis?
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Which assessment maneuver is positive in cases of plantar fasciitis?
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What is often true about calcaneal spurs?
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What is the most common location for Morton's neuroma?
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How does tightness of the Achilles tendon relate to plantar fasciitis?
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What distinguishes plantar spurs from heel bone spurs?
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What should be considered if clinical features of plantar fasciitis are absent?
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What is Morton's neuroma primarily characterized as?
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Which of the following is NOT a typical symptom of Morton's neuroma?
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What angle is considered abnormal for hallux valgus?
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Which of the following factors is NOT a predisposing factor for hallux valgus?
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Which tendon is involved in the rotation of the first metatarsophalangeal joint in hallux valgus?
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Which condition is characterized by a rigid flatfoot deformity due to congenital vertical talus?
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What activity is likely to exacerbate symptoms of Morton's neuroma?
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What is the primary cause of inflammation in hallux valgus?
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Study Notes
Bones of the Ankle
- Sesamoid bones are small bones found within tendons or muscles near joint surfaces, functioning as a pulley to reduce stress on the muscle or tendon.
- The two sesamoid bones, medial and lateral, are located under the big toe joint within the tendons that move the big toe.
- There are three axes of rotation in the human body: Anterior-posterior (sagittal), Mediolateral (transverse), and Longitudinal (Vertical)
- The talocrural joint's axis of rotation is oblique to both sagittal and frontal planes, requiring movement in other planes for complete dorsiflexion and plantarflexion.
- Dorsiflexion range of motion varies between 0-16.5° and 0-25°, which shifts with weightbearing.
- Plantarflexion range of motion is approximately 0-50°.
- The talus rolls within the mortise during dorsiflexion and plantarflexion with the talus rolling anteriorly and gliding posteriorly during dorsiflexion, and rolling posteriorly and gliding anteriorly during plantarflexion.
- The subtalar joint is defined as a one-degree-of-freedom hinge with a tri-planar axis.
Foot Muscles
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Extrinsic Muscles (Dorsum of the foot):
- Extensor Digitorum Brevis
- Extensor Hallucis Brevis
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Intrinsic Muscles (Planter aspect):
-
First Layer:
- Abductor Hallucis
- Flexor Digitorum Brevis
- Abductor Digiti Minimi
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Second Layer:
- Quadratus Plantae: helps with toe flexion in the sagittal plane
- Lumbricals: extend the interphalangeal joint
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Third Layer:
- Flexor Hallucis Brevis
- Adductor Hallucis
- Flexor Digiti Minimi Brevis
-
Fourth Layer:
- Plantar Interossei
- Dorsal Interossei: assist with MTP joint flexion, IP joint extension, toe abduction and adduction
-
First Layer:
Ankle Joint Ligaments
- Ankle instability can occur due to ligamentous injury.
- The anterior talofibular ligament is the most commonly injured ligament in ankle sprains.
- Clinically diagnosing ankle injury can include assessing gait, swelling, and tenderness to palpation.
Ankle and Foot Fractures
- Ankle and foot fractures are caused by falls, twisting injuries, or direct impact.
- Pain is a primary symptom, often worsening with weightbearing.
- X-rays are used to diagnose most fractures, but CT or MRI may be required in some cases.
- Treatment typically involves a splint, shoe, or boot designed for protection.
Plantar Fascia
- The plantar fascia connects the calcaneus (heel bone) to the toes, supporting the arch of the foot.
- Three distinct bands make up the plantar fascia: medial, central (plantar aponeurosis), and lateral.
- The plantar fascia stabilizes the arch during gait through the windlass mechanism.
Plantar Fasciitis
- It is now considered a degenerative process rather than solely inflammatory.
- Symptoms include:
- Insidious onset of heel pain
- Intense heel pain during the first steps after waking or inactivity, relieving with activity
- Pain worsening later in the day or with prolonged standing or walking.
- Risk factors include age, weight, and activity levels.
- Examine the foot at weightbearing and non-weightbearing; signs of plantar fasciitis include:
- Tenderness upon palpation of the plantar heel area
- Limited ankle dorsiflexion range
- Positive 'Windlass test'
Calcaneal Spur
- Calcaneal Spurs are bone projections on the calcaneus, which may be either dorsal or plantar.
- The etiology of these spurs is a complex issue and may be linked to degenerative, inflammatory, traction, repetitive trauma, bone formation, and vertical compression theories.
- Although they are not the direct cause of plantar fasciitis, they can be formed due to long-standing tension on the plantar fascia insertion.
Morton’s Neuroma
- It is a compression neuropathy of the common digital plantar nerve.
- Most often occurs in the third intermetatarsal space (66% of cases).
- Not a true neuroma but a benign fibrotic thickening of the nerve due to irritation.
- Risk factors include:
- Chronic, repetitive trauma.
- High-arch feet.
- Tight or ill-fitting footwear.
- Nerve ischemia.
- Repetitive heavy impact on the feet.
- Symptoms include:
- Pain in the forefoot.
- Pain worsening with increased activity or specific footwear.
- "Pebble" or "lump" sensation under the metatarsal walking.
- Sharp, stabbing, burning, or tingling sensation in the affected nerve distribution.
Hallux valgus
- The great toe (hallux) deviates laterally away from the midline towards the lesser toes.
- Less than 15° is considered normal, 20°+ is abnormal, and 45-50° is severe.
- Causes medial prominence of the first metatarsal head with inflammation of the overlying bursa and soft tissues.
- Predisposing factors include:
- Poorly-fitting footwear.
- Age and female gender.
- Family history.
- Pes planus.
- Achilles tendon contracture.
- Ligamentous laxity.
Pes Planus
- Several causes for flat feet include genetics, injury, and underlying medical conditions.
- Congenital vertical talus leads to a rigid flatfoot deformity.
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Description
Test your knowledge on the anatomy of the ankle, including sesamoid bones, joint mechanics, and range of motion for dorsiflexion and plantarflexion. This quiz covers the essential functional aspects of the ankle's movement and structure.
